Junior Player Consent Form
(Proposed by John Kellow and approved by Committee on 9th September 2019)
The safety and welfare of juniors in our care is paramount, and it is essential that we have parent’s/guardian’s permission for the child to take part in our activities and that we are aware of any illness, medical condition and other relevant health details so that the child’s best interests are addressed. Information on this form will be treated as confidential.
Name of Child: _______________________________ Date of Birth: ____________________
Telephone No: (Home) _________________________ (Mobile) ________________________
I confirm that I am legally responsible for the above-named child and I hereby give my consent for my child taking part in Club activities and those of Associations to which the Club is affiliated whether at its own premises or at an away Club. I consent also to information on this form being shared with other associations in whose events my child may play
I acknowledge that the Club will take all reasonable steps, in the exercise of its duty of care, to protect him/her from accident or other harm. I understand that, in the event of an accident or emergency, every effort will be made to contact me. If contact cannot be made I give permission for the Club or the responsible person of any Association to which the Club is affiliated to give the immediately necessary authority, on my behalf, for any medical or surgical treatment recommended by competent medical authorities, where it would, in the doctor’s medical opinion, be contrary to my child’s interests for delay to occur whilst seeking my consent. I accept that the medical authority will be informed of any condition/medication disclosed in the Health Profile overleaf
I also recognise that my child will need to travel to a number of venues in order both to play and support bowls and agree that he/she may travel by car, coach or train with any member.
I further consent to photographs and videos being, with the agreement of a Club officer, taken of my child during matches and competitions and agree that these images may be used in newsletters, on bowls websites and in local and national publications and newspapers. I note that I may ask for images to be removed from websites and that the appropriate bowls authority will endeavour to achieve this within 7 days of my request. Should I or my child become concerned that images may be being used inappropriately I will inform the Welfare Officer. My child by this signature confirms his/ her agreement to photos/videos being taken of him/her.
Parent/ Guardian’s Signature_________________________ Date____________________
The information in this profile is confidential and it is the responsibility of the Parent/Guardian to keep the Welfare Officer informed of any changes
Parent’s Emergency Contact Details: Tel No: ___________________ Mobile No: ________________
Alternative Contact Details: Name: _______________________________________________
Tele No: ___________________________ Mobile No: ________________________
Child’s Doctors Name: Doctors Surgery Address:
Telephone Number: Does your child experience any conditions requiring medical treatment and/or medication? Yes □ No □ *If YES please give details, including medication, dose and frequency:
Does your child have any allergies? Yes □ No □ *If YES please give details:
Does your child have any specific dietary requirements? Yes □ No □ *If YES please give details:
What additional needs, if any, does your child have e.g. needs help to administer planned medication, assistance with lifting or access, regular snacks?
The Disability Discrimination Act 1995 defines a disabled person as ‘anyone with a physical or mental impairment, which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities’.
Do you consider your child to have a disability? Yes □ No □
If YES what is the nature of the disability?
Hearing impairment: □ Learning disability: □ Multiple disabilities: □ Physical disability: □ Other: (please specify) Does your child have any communication needs e.g. non-English speaker/hearing impairment/sign language user/ dyslexia? If yes, please tell us what we need to do to enable him/her to communicate with us fully